Pain Started In Feet, Now Working Its Way Up Legs In Kidney Transplant Patient

[~Wingnut~]

Hi! Guess I'm probably asking this to Sqad but anyone any knowledge/experience of this I would be very grateful.

husband is a renal transplant patient (18% function) diagnosed with pneumonia approx a month ago, luckily caught early so no hosp stay. Same time ball of foot started to hurt (gout like symptoms) total agony, could hardly walk. Upped his prednisolone for a few days and weaned him back down to original dose, eventually pain was bareable but never totally went just carried on.
Back now to pain bad again but struggled on and the pain has moved up to his ankles and calfs. Doctor thinks it was never gout and referred him to podiatrist. Meanwhile he now is in so much pain he can't walk (work sent him home Friday as soon as he got there, been in bed ever since). Just what could it be? I justwant to help him or at least prepare myself for what this could be! Docs presecribed him Tramadol but dont want him to take it! Paracetamol upsets his stomach. Lost with what to do!

[Sqad]

Difficult....very difficult, but two things spring to mind, gout or cellulitis and the difference may well be difficult to differentiate.
It is interesting that upping his prednisolone improved his symptoms which would favour a diagnosis of gout.So as in interim I would suggest that you increase his dose of prednisolone again and monitor the response over the next 24 hours and get back to us.

[anneasquith]

why is he not taking the tramadol ?

[Sqad]

Sorry...I have missed a point.....is this affecting both legs or one leg?

[gness]

Hi Wingnut....Following his transplant MrG suffered very bad and frequent episodes of gout....twice misdiagnosed as fractures but definitely gout.

The only other problem he had with his feet and more the ball of his foot was solved by injections of B12. This may not apply to your husband as MrG had weekly plasma exchange following his transplant.

It does sound rather like gout....have you contacted the transplant unit?
18% function isn't high.....maybe that is a factor but Sqad will know that better than I...my memory of all that goes with kidney failure is fading.

[2sp_]

Have you been in touch with the Transplant Unit? Or is it his own GP that you've been dealing with?

[~Wingnut~]

Thanx Sqad. He was wary of increasing the prednisolone and only eventually did it because of being sick of the pain. He's worried it will affect the kidney with the function being so low so reluctant to do it. Stubborn is the other word but I can understand why he feels this way.

Anne, the Doctor told him there wasn't much they could give him because it would affect the kidney and the tramadol was the same and he must only take it if unbareable, to him he feels its not worth the risk.

[gness]

Wingnut.....the doctor prescribed painkillers for MrG. I checked with the transplant unit and they were likely to damage the kidney. He was then prescribed safe painkillers by the renal doctor and that is who I would always ask for advice after that.
The treatment of a renal patient is not easy and it's better to talk to the ones dealing with it all the time.

[~Wingnut~]

Sorry, not ignoring you all, not quick enough typing!

yes both legs. He has been to our GP who has been in cahoots with his renal unit at Jimmys, so they are aware but not asked for him to go in. They are trying to keep the kidney working for as long as possible so tweaking tablets etc hence why they dont want to prescribe painkillers that will affect the kidney.

thank you to all for your replies xx

[Sqad]

wingnut......No, increasing the dose of steroids to ease the pain would not, in my opinion have a damaging effect on the kidney.
i stand by my diagnosis of gout and recommendation of increasing his steroid dose.

[gness]

I hope you get some help soon, Wingnut......we need to get the best we can from a donated kidney and for as long as possible.

Not in any way telling what to do but when things were very bad with us I just took him into the renal unit and said...help please.....x

[~Wingnut~]

Thank you gness, I said to him that I think he should ring Jimmys and let them help him but I think he was hoping GP could solve it. I find it tricky trying to get him to do stuff like this as he finds it very difficult to cope with sometimes. He had a break down a few yrs ago due to a life time of bad health and had basically had enough and he refused to take any tablets. I kind of wanted to know what I was dealing with so I could prepare for what was going to come next. He isnt going into work tomorrow so will make sure he rings renal unit xx

[gness]

Not in an easy place are you....I was really lucky with MrG who had an amazingly positive attitude but I have seen people become so down with the constant treatment and medication just to stay alive without getting much better.
Is he worried about the possibility of returning to dialysis? I know that is hard for some to come to terms with again.
Am I mistaken in thinking you met after the transplant?...I may be wrong there though....
Do ring the unit tomorrow....and let us know how you get on...Gx

[~Wingnut~]

Hi gness,
His first transplant failed about 3yrs after we met (1yr married) he dialyisedfor 4yrs then had his second transplant when our youngest daughter was 2 months old. He's often said dialysis is just a slow death and that hes not sure he will do it again, this was when he was at his lowest and now says he would go thru with it but only because of me and the girls. I can see why he feels this even tho i just want him here, but then how selfish am I?!. Surprisingly he is quite positive and says lets worry about it when/if it does happen. When it does happen I am going to see if I am match Whether the silly old bugger likes it or not lol xx

[gness]

Good for you Wingnut.....MrG couldn't have a live donor transplant because of the type of renal failure he had but had a slightly damaged kidney from a dead donor as an experiment....
The plasma exchange in the years following the transplant was done because I had a gut feeling it would work despite the reservations of the doctors. I had to battle for it but it was a battle worth fighting....MrG died with a perfectly functioning kidney and others now benefit from the experiments.
You do need strength to go through all this but I feel you have that strength....Gx

[~Wingnut~]

Thank you gness xx

[gness]

Hi Wingnut......any improvement?.....x

[~Wingnut~]

Hi Gness! Thank you for asking :)
He is a bit better after some rest. He refused to take extra prednisolone and to ring Jimmys insisting he will wait and see how it is in a few days :/
He now has an appointment for a weeks time to see a podiatrist so hopefully they will be able to help. He's also going back into work today so must feel a bit better and says he will come home if he can't manage. He is moving about better but I really don't know how he will feel after being at work all day like this, he's clearly still in pain.
I know he is hoping that it will just eventually stop hurting if he waits long enough but I think it may take more than that.
Thank you all again for your help. I will update once he has seen the podiatrist :)
Xxx

[~Wingnut~]

Just a quick update;
He went to Jimmys this morning after coming home from work early yesterday with swollen feet and ankles and in a lot of pain. Must have scared him because he rang clinic as soon as he got in after saying he would wait to hear what the podiatrist said! Saw them this afternoon and Long story short they think he had ripped a tendon or ligament?! Dunno how as he doesn't play football or do a sport other than walking the dog, which he cant currently do as he's in so much pain. They want to see him again in a few weeks and also do an ultrasound scan. Meanwhile plenty of rest, which he wont get at work so may have to take some time off sick and use a hot and cold compress on the area. Hopefully this is all a step in the right direction and he will be pain free by Christmas :)

[~Wingnut~]

Sorry missed out a bit; clinic seemed happy that his kidney was still functioning ok and that it wasn't causing the pain or swelling, taken loads of blood to give him a good check over :)

[gness]

Hi, Wingnut....good news about the kidney function.....good kidney news is always such a relief.

Sqad mentioned gout and my experiences of gout being missed so many times would make me say always keep it in the front of your mind..... especially with kidney patients.

Hope things improve for you both...chat any time though my knowledge of kidneys and transplants is fading and probably out of date....but I'm always an ear....Gx